- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.67 / $1,471.56 / $1,590.09
| Professional | | $1,108.67 | $1,471.56 | $1,590.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,587.56 / $4,845.46 / $5,736.45
| Facility | | $3,587.56 | $4,845.46 | $5,736.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.47 / $1,333.49 / $2,230.16
| Professional | | $1,133.47 | $1,333.49 | $2,230.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,467.70 / $1,787.17 / $1,787.17
| Facility | | $1,467.70 | $1,787.17 | $1,787.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.63 / $1,304.63 / $1,304.63
| Professional | | $1,304.63 | $1,304.63 | $1,304.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.13 / $1,506.88 / $2,109.82
| Professional | | $1,144.13 | $1,506.88 | $2,109.82 |